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Should Asymptomatic Sleep Apnea Patients Be Treated?

Once in a while, I’ll come across someone with moderate or severe obstructive sleep apnea who feel fine. They deny any sleep problems or any daytime fatigue. In this situation, it’s hard to convince the patient that he or she should use CPAP or oral appliances. Here’s another study that shows why it’s important to treat obstructive sleep apnea, even if you’re not tired: Researchers from Spain showed that treating asymptomatic sleep apnea patients significant lowered their cardiovascular risks by 28%. Furthermore, sleep apnea patients with hypertension had a 50% reduction in cardiovascular events if they used CPAP for at least 4 hours every night.

If the patient is still resistant, I give the following example: If you had high blood pressure or diabetes, you’ll feel fine, right? But if your doctor told you that despite dieting and exercise, your numbers (blood pressure or glucose levels) are still on the high side and medications were recommended, would you consider it?

Do you have obstructive sleep apnea and are completely symptom free? If you’re on some sort of treatment, what motivated you to start treatment? I’d like to know. Please enter your reasons in the text area below.

If apnea can be asymptomatic, why are we only asking people to get tested only if they fulfilled the questionaire as in only if you snore, only if you haf EDS? dont you think everyone needs to get checked even if they dun haf symptoms as apnea can lead to all kinds of diseases later on.

Because so many people have undiagnosed, you could make an argument that everyone should be screened for OSA. This can take the form of a simple questionnaire (STOP-BANG or Berlin) or even a simple home sleep study. The problem is what do we do with all the newly diagnosed OSA patients? We’re already backed up with sleep labs and overall, the system does a poor job in treating everyone. It’s definitely a dilemma.

I have been diagnosed with sleep apnea 40 years ago. Over the years I have had laser surgery on my throat, surgery on my nose and have never used the CPAP machine. I do not hold my breath any more when I sleep I beleave I am asymtomatic sleep apnea. I am now starting to get headaches even when my blood pressure is down. I am now taking blood pressure pills. Why am I getting headaches?

My primary care physician, based on my fiance’s concerns, referred me for a sleep study. I didn’t get the sleep study even after my initial consultation with the sleep doctor. The reason why is that I have no symptoms. None. I videotaped myself sleeping several times and not once did I stop breathing or for that matter have shallow breathing. I tried to explain this to the sleep doctor however he didn’t want to hear what I had to say. I’m overweight and snore so therefore in his opinion I needed a sleep study. At some point the patient and the doctor have to consider everything. I would not suggest that I made the right decision but why go through a sleep study when there’s seemingly no obvious reason for it? And I understand the long term effects but aren’t those long term issues based on the symptoms a person feels? I’m of the opinion that there are no long term effects if there isn’t any problems in the present

I don’t think anyone can force you to undergo a sleep study. However, what the research shows is that even if you’re completely asymptomatic, you have a significantly elevated chance of having obstructive sleep apnea. Snoring alone without apneas are known to raise your risk of stroke. Like the examples I gave above, if you had high blood pressure or diabetes, but felt completely normal, would you refuse treatment? Also, video taping or recording a snorer is extremely unreliable. You can have subtle breathing pauses with disturbed sleep without any obvious apneas. Worse case scenario, the test will come back normal and you can tell your doctor “I told you so.”

I believe that my issue with the sleep stems from too many people suggesting the sleep study without a care in the world as outside circumstances that more than likely have nothing to do with sleep apnea. I get that no one can make a person have a sleep study however it’s more likely that without a doctor willing to sit and talk to a patient as opposed to simply ordering one based on what he sees and not the history of the person is wrong. I don’t snore loud. I don’t feel tired. I don’t have high blood pressure. I don’t have diabetes. I do have pain in my leg but I tried to explain that the pain was due to a torn meniscus and I was having surgery in a few days to address that issue. I don’t have headaches. Nothing. My fiancee felt that I may have had sleep apnea because I was always tired a few years ago. But I should have been tired. I worked literally seven days a week at no less than 18 hours a day. I did this for close to five years to be able to have enough money to start my business. Steve I don’t doubt that asymptomatic sleep apnea is real or harmful but when a person has absolutely no symptoms I find it hard to justify a sleep study. If I had high blood pressure or diabetes yes I would address the issue however there had to be a trigger such as constant headaches or frequent urination to make one go check the issue out. But a completely healthy person has no reason other than getting a physical to see the doctor. And persons who are asymptomatic honestly don’t have a need to see a doctor. And lastly I appreciate your response but it still in my opinion address the issue of one whether or not just being slightly over weight and snores is a reason to believe someone has sleep apnea and two is it the issue of not getting enough oxygen the cause of the heart issues and if you’re asymptomatic doesn’t that mean your oxygen level is pretty much normal? If it wasn’t you couldn’t be asymptomatic. And if my thoughts are true then shouldn’t doctors address the total history, sleep and health, before ordering a sleep study? Thanks again for the response.

All valid points. We jumped ahead to the issue of whether or not to undergo a sleep study, but as you pointed out correctly, the first steps to address are always conservative, lifestyle modifications and optimizing sleep hygiene. If that doesn’t work or new symptoms arise, then testing can be considered. Having said this we know that a large number of completely asymptomatic people will have significant obstructive sleep apnea. Whether or not we need to treat all these people is a challenging question to answer. If we tried to treat the 90% of people that are not diagnosed, then it may bring down our health care system.

Well you’ve been very helpful. I’m having surgery tomorrow and the nurse asked me about sleep apnea based on the referral I had from my primary care physician. Hopefully there are no issues and thanks again

Last June I was admitted to Hospital and diagnosed the community acquired pneumonia. I am male, 69 years old and in reasonably good health otherwise. However, I did respond to intravenous antibiotics and a few days later was switched to oral antibiotics, but felt very ill for quite a time. Naturally, I had very disturbed nights with my persistent coughing, an overheated and noisy ward making it almost impossible to sleep at night. Whilst lying there one morning a doctor who I had not seen before stopped by my bedside and said I had sleep apnoea and asked me if I knew what that was. I said I thought it had to do with breathing issues during sleep and he agreed and went on to say that they were going to carry out an overnight pulse oximetry test. During the day I used my smartphone to research OSA and became convinced that if I did have OSA then I was completely asymptomatic! I do not have any tiredness issues during the day, I do not snore very much and have no gasping events typical of OSA (all this confirmed by my wife). I am not overweight, not hypertensive, or suffering from diabetes. When I completed the Epworth Test I scored 7 and when my wife completed the test as if she were answering for me, she also scored 7 and ticked the exact same boxes. The hospital pulse oximetry test was a farce. The Konica Minolta device was attached to my wrist by a nurse who offered no guidance as to the necessity to avoid excessive movement (remember I was thrashing about with convulsive coughing bouts as I was still in the throes of pneumonia). Sometime, in the night she came to check the device and found it was dead, Subsequently she discovered the battery had failed. Despite this they apparently retrieved enough data to record an average of 9.8 events per hour.

I am completely at a loss as to how a ‘diagnosis’ of OSA can be made on a asymptomatic patient in the throes of pneumonia and no one has been able to explain this to me. When I ask they point to the oximetry result, but the doctor’s ‘diagnosis’ of OSA was made prior to these results being obtained. They supplied a CPAP machine 8 weeks ago and I bought my own pulse oximeter. When I did an overnight test recently (now the pneumonia has cleared) I obtained a result of 5.3 events per hour without the CPAP machine and on another night 4.7 events per hour when using the CPAP machine.

To conclude this tale I was also diagnosed with Atrial Fibrillation whist an in-patient with the coronary physician’s opinion that it was likely triggered by the pneumonia. My CPAP review is due tomorrow and I am of the opinion that if I have OSA at all it can only be a mild case, what do others think?

Yes. For some reason my doctor thought I had sleep apnea. I agreed to get tested and have moderate sleep apnea. NO I don’t have daytime sleepiness. (I hate the word “deny”, sounds like I am lying. No one uses the term “allegedly has daytime sleepiness”.) My Epworth scale is 4. I do not take day time naps. They want me to use CPAP which I can’t get my mind around. I’m worried that on oral appliance could put my jaw out of whack. No one recommended anything conservative, though I’m not overweight so maybe there was nothing to recommend. On my own I’ve found some less drastic things, but nobody has recommended these (provent, tongue “extenders”, etc.).

My doctor and fiance believe I have sleep apnea however I do not have diabetes, hypertension, depression, day time fatigue, or any other health concerns other than arthritis from old sports injuries. Actually my major concern sleep wise is that I never feel tired. I sleep 3 to 4 hours a day and go all day every day. My fiance has to ask me to stay in bed as I’m usually up and running about. So why would treatment benefit me?

There are a few rare people who naturally only need 3-4 hours of sleep. However, the vast majority of “short” sleepers do so either from intentional short sleep, or wake up naturally after 3 to 5 hours due to obstructed breathing (without knowing it). Without a formal evaluation and testing, another way to gauge if treatment is needed to to look at your parent’s medical history. If they have any of the consequences of untreated sleep apnea, then I generally recommend treatment. Hope this helps….

My doctor has asked me to do a sleep study as my fiance told her I stop breathing during sleep. However I do not have any sleep apnea symptoms. None. However she still referred me to a sleep lab. I went but left as I couldn’t stand the thought of being touched and wired up by a stranger. So she suggested a home sleep study but I just don’t want to have a study. I’d rather lose weight (though I’m having a hard time doing this as my fiance complains when I go to the gym so I don’t go that often). But again I don’t have any symptoms so I’m choosing not to have a sleep study. No high blood pressure, no diabetes, no day time sleepiness (usually sleep 3 to 4 hours a night and bounce right up for the next day). 40 lbs overweight too. I just can’t stand the thought of having wires attached to me so as long as I don’t have any issues I’m choosing to not have a sleep study.

I have a slight devated septum chronic sinusitis and bronchitis and allergies constantly sick I do take herbs for sinus such as Collinsonia. What’s your thoughts on sinus surgery or is there something like balloon pasty I heard where I wouldn’t be chronically I’ll I also try to stay away from wheat diary sugar is there a doctor you could recommend in the Albany or Saratoga Springs New York area I live in the Clifton Park area

neurologist visit with sleep study bc i was biting sides of tongue when asleep showed moderate apnea but i am not symptomatic at all. Yesterday began using oral appliance but not very motivated to do it. I am female, 69 yrs old, and don’t see why this is necessary at this late stage of my life. I am being treated for hypertension and cholesterol but otherwise healthy.

Had extremely mild snoring, but as I’m a “preventive medicine” kinda gal with a father who must have had undiagnosed apnea, I thought I should be tested for sleep apnea. Biggest mistake of my life!! Had low blood pressure, no cardiac risk factors, slept wonderfully and awoke always feeling full of energy. No daytime drowsiness unless I had very poor sleep hygiene, watching TV late into a.m., driving hundreds of miles, etc. Had sleep study (from facility that later closed down) & they said I had sleep apnea. Put on Resmed device with pressure ranging from 6-16. Awful stomach pains resulted, didn’t sleep, miserable. Changed doctors & he ordered new CPAP test, but not sleep study w/o CPAP even though I had lost 25 lbs & no longer snored!! He said pressure was too high & set DreamStation at 6 pressure. Ever since 1st sleep study, I am weirdly conscious of my breathing, even during day. With CPAP at night, I wake up tired! Where I had wonderful sleep before, I now feel terrible. HATE the device & 3 diff masks I’ve tried. Believe with weight loss, I may not even have sleep apnea anymore. But physician won’t even consider tbe possibility! HATE CPAP!!

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Dr. Steven Y. Park is an author and surgeon who helps people who are always sick or tired to once again reclaim their health and energy. For the past 13 years in private practice and 4 years in academia, he has helped thousands of men and women breathe better, sleep better, and live more fulfilling lives.

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